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Home My WebLink About2708 ALBATROSS DR - Building PermitsJobAddress: 2708 ALBATROSS DR Suite No Vicinity: Parcel Nunmber: 13947612 Applicant Address: Owner: Address KAREN BRIDGES MILBURN, RODNEY 2708 ALBATROSS DR COSTA MESA, CA Contractor. PLUMB IN TIME Address: 360 MEMORIAL DR CRYSTAL LAKE, IL WATER HEATER CHANGE-OUT ISSUE FEE Backflow irrigation Backflow Preventer Balhtub Clarifier System ' Connect pce,Soda,etc) Dental Units Dishwasher Drein, Floor � Drain, Rainwater Drain, Roof Drinking Founlain Expansion Tank Gas Earihquake Valve Gas (1-4 outlets) � Gas (Over 4 outlets) ' Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT 523.50 50.00 50.00 50.00 $0.00 50.00 so.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 : $0.00 . $0.00 $0.00 $0.00 $0.00 arv Phone: 866-2933031x1042 Zip: Phone: Zip: 92626 Phone: 866-293-3031 Zip: 60014 License: 868068 � SCOPE OF PERMIT FEE SUMMARY AMT Laundry Tub / Washer - $0.00 - Landscape Irrigation - $0.00 P-Trap $0.00 Pressure Regulator $0.00 � Process Piping (per 10 N) 50.00 _ Receptors 50.00 SepticTank $0.00 Sewer Cap (or Demo $0.00 Sewer Connect . 50.00 Sewer Private Line 50.00 Shower - $0.00 Sink, bar §0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $0.00 �, Sink, servicelmop $0.00 ��. Spa (private) $0.00 Spa (public) $0.00 an 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COMMENTS / SPECIAL CONDITIONS ISSUED BY: Status: ISSUED Applied: 02/20/2007 Issued: 02/19/2007 c:/ � Sump Pump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Healer / vent Water Piping Qnst or Rep.) Water Re-pipe Waler Service Waler Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 50.00 50.00 50.00 50.00 50.00 50.00 $0.00 50.00 $12.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 50.00 TOTAL CALCULATED FEES: $35.80 Qn 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § t, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 24d646 (N00) PHOJECT AODHESS: OWNEfl'SNAME: 2�JOB ALBATROSS DR nooness:MILBURN, RODNEY 7.�08 ALHATR05S DR COSTA MESA,CA 97,625 FflCHIENGINEEF: � 7 1 4 J S S%— Z 3 Z Fl pEG.NO.: AUOflESS: uNir: UNIT: � PEHMITTEE: nooaess:CRANK BRO'CFiEAS ROOFING ( 714" ) 548-5569 !�1?.6 COpMqMpEftCIAL WAY (`� � "7 LICENSED CONTBACTOfl DECLTA�RTION:"I'tlErEby aHirm I am licensea unde�'ptoviso R5 � C�ap�er 9(commencing with Sec�ion 7000) o� Orvision 3 nl ��e flusiness and Pmlessians Cod an my license i5 in lull �orce ifect. CITY LIC.: STATE LIC.: CIASS: , 005993 40867 .�y �ate�s //_ ;_ Signature: _ _ �� WONREBS' COMPENSATIO UECLAflATION: I �ere m t�al I have a certilicate ot conseni Io sel -insure or a certi�ica�e ol Workers' Compensaiion Inswance. or a certitietl coDY �her (5 tion 3800. Lab. C). voucrr+o.:285-93UNIT00 �.j E%P.OATE:OS�OSI��I comvaNr:5`CA'k'F FiJN�3 ❑ Certilietl copY is ere6y fum�she � Ceriitied coDY � i�h th ciry Building Division. �o�, , �ate. � � �� Applicant � /--� � E%EMPTION FNOM WOHREHS'COMPENSaTION OECIANpTION: (Thisseciion neea no�0e wmpleteaiilhe permiiisforone hunOreA�$100)orless�. I cetlify Ihal m I�e petlarmance ol �he work lor which this permit is i55ue0, I shall no� employ any person in any manner so as lo become suble�� o I�e Workers' ComDensa�ion Laws of Califomia. Da�e: SignaWre: NOTICE: II. after making Ihis tleclaralioq you shoultl become suhlect Io Ihe Workers' Compensa�ion pmvisions of Ihe Labo� Code, you must fotlhwilh comply wi�h such pmvisions or Ihis permil shall be tleemed revoked. CONSTqUCTION LENOING NGENCY: I hereby affirm Uat there is a constmc�ion lentling agency lor ihe pedormance of �he work for which Ihis permii is i=_sued (Sec�ion 3097. Civ. C�. LEN�Efl: AOUXESS: OWNEB BUILOEfl OECLAHATION: I here�y allirm Na� I am exempi fmm t�e Contractors' S�ate License Law for ��e following reason (Seclion 7031.5 Business antl Pmiessional Cotle: Any city o� counry which requires a permit lo cons�mct, alter, impmve, demolish, or repair any Slmclure, prior to its issuance, alm repuire5 ihe ap0licant �or such permi� �o file a 5igne0 statemen� �hal hGshe is licensed pursuanl to the pmvisions ol lhe Coniractors' S�ate License Law (Chapier 9(commencing vn�� Seaion 7000) oi Division 3 oi Ihe Business and Pmlessions Code) or ��ai he/she is evemD� �herelmm antl �he basis �or the allege0 exemption. Nny violation o� Seciion 7031.5 by any applicanl for a permil subjects Ihe applicant �o a civil penalry ot nat more Ihan live �undred tlollars ($500�. I, as owner ol �he proDerty o� my employees wiN wages as �heir sole compensation, will tlo lhe work, antl Ihe ❑ simc�ure is not intentled or ofiered for sale (Section 70ad, Busmess and Pmlessional Cotle: The ConVaciors' Sta�e License Law aoes noi apDly lo an owner ot a pmpe�y wha Oui105 ar impmves t�ereon, an0 who Jaes such work �imsel�/hersel� or Ihmugh �is or her own em0loyees, pmvided ihat such improvements are no� inlen0e0 or oHereO for sale. 11, however the �uiltling or impmvemen� is sold wit�in one year o� comple�ioq I�e owner will have Ihe bur0en of pmving �e/she tlid no� builtl or impmve lor�he purpo5e of Sale) I. as owner ai Ihe pmDehy, am exclusively contraqing wi�� licensetl comracmrs m conslmc� �he Dmjec� (Sec�ion 7044, eusiness ❑ antl Pmiessions Cotle: T�e Contraclors' State License Law does not ap01y lo an owner o� pmDerty who builds or improves �hereon ana who contracts for such pmlecls wi�h a tonVactor(5) license pursuanl �o �he Contratlori' Staie License Law�. I am aware Ihal pmo� o� ��eir Worker's Compensation insurance should 6e pwvitletl to me. � I am exempt untler Sec�ion'. 8. 8 P. C. lor I�is reason. Oale: Owner I tlo here�y cenily Ihal I am aware o� and untlersiantl the requiremems o� Cali�omia Healt� anU Safery Cade Sections 25505, 25533, antl 25534 and iha� I ar any Wture builAing occupanl will/will not (circle one) nee0 �o comply wi�h said state cotles antl the requiremeni5lor a Oermil for cons�mctwn or moddication imm Ihe Nir Ouali�y Managemen� �isVict. Resitlential conSUuc�ion applica�ians are exemp� Imm Ihese pmvisions. Oa�e: ADPlicanl: I hereby cetlilythal I �ave reatl ��is applicalion antl sta�e artlmances antl sta�e laws remmlaiing �a Ouilding constmc�ion. prapetl fur in�tion �o=es. Daie: Signalure: Driver's License or Social Secunly v: � Applicanl', Pink—Revenue: Goldenrotl—Assessor � � �„ CITY OF COS'TA MESA — BUILDING PERMIT PERM NO; B 061400 PERMIT NO: B 06140Q PL'AN CHECK NO: N GOV'P; N SUPP: N CONSTkUCTION TYPE; 5—N PERMIT TYPE; STR PUftPOSE; ALT JOB DESCRIPTION : T/O EXISTING S APPLY 'HOT SYSTEM 6 ROCR' SQ FT; 2,911 CLAIM VALUE: 2,911.00 CAi.C—VALIIE; 2,911.00 GROUP OCC; R-3 / COMMENTS: SMOKE: DETECTORS RE�UIRED PER THE 1991 ED. OF THE UHC, iEi(iEiErtiE3EiEiEiEifkiFi4iflEiE�E*iFlFitiE3EffiPi(�ih� iE�lEiiiFkiEiEjEif�3EiElfik�k3E#i(-�IE%�3E3E1EiPiEii�3EiEif�iEK�ifi!-if�#jtif�fifiEi(�3FiF#�if�E�7f-lE#jF�)(- Z O N I N GS EkTEHQAUCIxRSE M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT; FT IN REAR; FT SN FRNT; F7' IN REAR; FT IN LEFT; FT IN RGHT; FT IN LEfiT; FT IN RGHT; FT IN PARKING REQ• PROV; PARCEL: 13947612 ZNE:; REF NO: PLANNING N(5T'ES> , �. 3f� ih fF iE 1F if fE iE 1f iF iE iF if iF'�-iE if K K� iE iE 1E %!F )f'!f if it iF iE !F iP iE df�lF �7E if �f i6 ic 1F ih it iE 1(� #%� 3F fE i! �7k iF IF 3E fE �l(� 7Flf lEll� �I41h �)t #�1b 1F �14 3!�?E i(�iE iF # iE iF if 3f 3l-1't D E V E_L, O i� M E N T S E 12 V I C E S R E Q U I R E M E N._'1' S � � . . ZONING APPROVED BY DATE: BUILDING APPROVED HY APPLICATION IS'SUED BY:—__--� iFfEifiF#�IFIE-IEiEiFiEiE1Ei2-1Ei(-%iEiEiF#N�TF ti iE 1E !E ik ih iE If- 3f i( if ik 3E if iE # it af it 1E # ih 3F 3E ih iP iF it k 1E iE lE iF �7t it LEGALI7.ATION;N F E E BLDG PMT PLUMBING PERMIT 54,00 PLAN ISSUE FEE S U M M A R ELECTRIC MECHANIC ��' , DATE: �: %�-�-, DATE; "-3 l� 3F3F£�R�t'iF#fFitK��lE�7F#iF#if� 1r lrnx�f K- K� K� # 3F #�IE if iE If #S 1E iF if� # je iE iE 3E # 1(� iF %if i@ K� �IblF ST'RUCTiJRAL SEGMENT;Y FIRE SMZP/R50 GRADING SMIP/NON—RES BUILDING—DIV—> PEkMIT IS5UE PLAN—CHECK TU'1'AL PAID DUE TOTALS----> 54,50 0,00 �� 0,00 59,50 54,50 ,00 REVENUE DIVISION TOTALS--> COLIt�$CTED; 54,50 UVER/SHOkT: 00 BLDG PMT PLUMBING ELBCTRZC j�iECHt1NIC FIF1E SMIP/TOT GRADTNG PLAtJ—CHECK 54.00 . ,50 �. iF iF i! i! 1f if �lE it if i! it 3E iE �1E if #!f i4 iE !f !4 !k k iE iE it iFlf ik iE 3E iE iF If k�161E �1E iE if iE iE iC-iE �FlflFik iF ik iE iF �k �1F ik 3f iElf !f �IE iE 3E iF 1E iEll� 1ElE'.(� if �7h K-if 3l-if 3F iF # iE I N D I V I D U A I, F E E B R F. A K D O W N � TYPE QTY D E S C R I P T I O N UNI1' COST TOTAL COST SFR 2911 REkOOF BY VALUE kESTDENTIAL NOZONE 1.00 2,911.00 ''�ND OF F'EES �MAD '�,' � �� ,' y 1 p R 199.� � CIIY F COST;rt ft4�$A CONSTRUCOON AND PLANNING APPROVALS Permit,'� 1. Temporary Electrica� Service or Pole 2. Sod Pipe-Undrgrnd. . 3. Elec!ricai COnduit Ut��ity�Undrgmd. 4. Electnca7 Conduit•Undrgrnd. ' 5. Steei Reinforcemenc �. Electrical UFER Grnd. 7. Foo2ings . $. Foundation -� 9. Water Pipe�Undrgmd. � 10. St�uctural FIoO� SySteT 'j it. Property Sewer �ine & House�ConneCtion'��, 72. Se�,ver Cap . . '. 73. Roof Orains ' 14. Rough Plumbing � 15. Rough Electrical-Condurt 16. Rough Electric Wiri�g 17. Rough tNiring Sigrt t8. Rough Electrical-T 8ar Ceiimg t9. Rough Heaiing & Air Condition�ng 20. Rough Factory Fireplace 27. Ducts, in Structure 22. Ducts, Ventiiating 23. Gas Pipe�Rough & Tes[ 24. Roof Framing 25. Roof Sheathing ; 26. T-0ar Celling (Struccurall & Monocoat 27. Frame and F�ashing 28. Lathing & Siding 29. Insulatio� 30. Drym,�ail Nailing 37. Plasrer Brown Coat 32. Electrical ?ower MeterFinai 33. Final Electric � 34. Final Heating & Air Conditioning 35. Final Gas Pipe�Test 36. Hood or Canopy 37. Fina1 Factory Flrep�ace 38. Finai Plumbing 39. LNater Service�Fina1 A0. Gas Se�vice-Final � __ _. 41. Solar pomestic-�inal 42. Beakflow Preventer 43. Backftow Irrigation d4. �andscape Irripation SYstem 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING 48. FiNALPLANNiNG 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY Date Date v Inspector 0 P(,,,� & SPA APPROVALS Permit;$ 52. Poo� & Equipment Locauon 53. Steel Reinforcement 54. Forms 55. Electrical8onding 56. Rough Plumblrg & P�cssure Test 57. APPROVAL TO COVER�GUNITE 58. Electrical Conduit�Undrgrnd. 59. Gas P�pe, C'i Jr�rgrnd., Test 60. Backwash �ines, P-Trap, � Undrgrrd. 61. APPROVAL TO DECK 62. Backwash & Recept�r�Finai 63. Neater & Vent-F��nal 64, Piumbing System � F�nal 65. Electrical-Final 66. Solar SY>tem-Final 67. Fencing & Access Approval 68. APPftOVED FOR PLAS7ERIfJG 69. POOL/SPASYSTEMMSFINAL FIRE DEPT. REQUiREMENT APPROVALS Permit � Date f tnspector 70. Underground Hydro 71. Product P�pin9 � Gas C 0�1 72. Underground Fiush 73. Undergrnd.StorageT2nk OGas � Oi! 74. Overheatl Hydro � 75. Dry Chemical 76. Dry StandpiFe 77. FIXED SYSTEhS FINAL 78. FIRE PREV. FIhAI HEALTH DEPT. REQUIREMENT 79. fINALINSPECTION 80. FOOD CERTIFICATE ISSUED �_J T�rr. ,.4 p'; � - - i. i --��-2� ,-. ., �'Y- ' .i1, � .�-rr:• t.. . •.: r _ •-� �� ,, 28828 + COSTA MESA BUILDINGSAFETY DEPARTMENT p. p, 90X 1TL0 COSTA MESA� CALIFORNIA 92020 For AppltmM ro F(11 In Comptetdy TYPE OR PRINT ADDR6II6 iL � CQSTA MESA. CAItFORN1A � � � � G 9t� o':'a°"slb < '�X.od I�o; e�oo. /�e5�`9e.✓G H61ROtl L�"T � RGR 8THi6T d v )I �err �0 � � �� n�oerr DESCRIPTION OF WORK � BUILDINO �� i 1 XCRelY ACKNOWL[DO[ TNAT.1 MAVB p{AD YNI� AP�LIGTON ANO 8TAT6 TX�T TM[ AlOV�.18 CORR[CT ANO AOpC['1'O COY. PLT WITX ALL CITY ORDIWHiCp AqD {TAT[ LAYH p[OYLATXO euuuwo consrnurn �. H16NATUR80F �� P8RM1TT6�-- - - AUTNORIZ[D A6[dt 11A 72�68vaioOO 996* *t**27.00 CNSA A►PLICATION FOR PERMIT BUILDING for Off)ce U» Only R[C[II�NO. �upql NO. �-� � A V' �r . wra n�c�rveo _ wa �eaueo . BY' �Ll/if�DAT! /'/ O—/n ZONING zons no.or usaorxcw i36o�zoer�� •uxs � suno�no garti ' Per� �wimon lAi� O � � 1l ' �2-fi9 A.P.NO. � �i�I — 4�� ' �Z N0T6: NO PJ1VE OVERNAN6 BXALL D6 LQ88 TXAN 80' TO 8ID8 ! REAR P. L 8AVE8 ALLOWED fU.B.C.REQUIRHMHNT) YARDDAPPROVED YARDSAPPRDVED MAIN BUIlDIN6 ACG69HORY BUILOIN6 DI6TANCC �6T. � BET. MAIN R MAIN BLD6G. ACGESS. BLL VAR.# OAT6 TN[ IINOYNT /HOWN UHD[p VALUATON IB FOq TXi ■UXPoB[ 0► ftt11GYBNINO A VlqNIT F66 ONLY. VALUATION PERMIT FEE S �l.�?, °� TOTALPEE v[ •(lL P� � w Urvrv[tt 1SUWWUSKl� '1'. UAIt f-1(-00 JOB ADDRESS270 Albatross BUILDING PERMIT N0. •GAS W ATER ROUGH PLUMBING PROP. SWR. LINE � HOUSE CON. �� SPRINKLING SYSTEM MISCELLANEOIIS FOUGH HEATING AN� AIR CONOITIONING TEMPORARV SERVICE OR POLE UNDERGROUN� � POWER � ROUGH WIRING TRENCHES n FORMS i70 STEEL REI r- FLOOR SVSTEM BONO BEAM n STEEL REINFORCE � SMEATNING FRAME ANO FLASHING LATHING - IN I� OIIT IRI %-E SPECIAL REQUIftEMENTS SUBCONTRACTOR ': `. " 42742 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fdl in Completely — Use Ink Only BUILDING r�.� _ ,_ .��„ ,�� _ , _ FS FL [ii a Q � � s F 0 tr] F Q Ca ..1 Q � �^ ..l a W L � a 4 z � 3 OWNER MAIL CITV L(��C �. h CONSTRUCTIO�� LENDER BRANCH ��^ �i ADDRESS ARCHITECT � 'f ?"l-7F�:' ��i36G :� �..•:: �%7.ii� PORSTRUCTURALPERMIT �- -' BVILDING ADORE55 TEL. TRACT NO. NEW ADD � OWNER TEL -�� USE ��VI CONTRACTOR�`�� f„y��p�� A�� ADDRESS��Si�Y �ffLL,p/jy � � �/� TEL.�7� �i CITV FGLLCL/UM NO•�7YLC STATE CITV uc. No. � b 6�S'Z. LIC. NO. S I Z E NO. OF BIDGS. OF LOT NOW ON LOT EXI5TINGBLDG. ,S'/nj�Lt �.n�LG �CJ/ V• �„i Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AN}� WOfiK TO BE PERFOR r/ih'IG f' /C�S _ r .�� /'Y! /1 ,. _ � 1 w // . �, _ ED ZONE NO.OF PLANS '� VARDS APPROVED ��'� ; o % Pc.1S �D.�- DATE '7 �/ / " E OF NEW� LDINGr�/ �/ p� VARDSAPPROVED CCESSORV BUILDING / / REAR FT. 4 FT DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BLDGS. VAR. # DATE QU.P.� APPROVED APPROVE�/1),.� ^^Tc Q J. v l/U" / I haraby acknowledga that I have reetl this application antl state that the above Informallon is correct and apree to comply with all laws regulating builtling construction, and I shall not employ any permn in violatlon ot the workmen's compensation lews of the State of Californie. I haraby ce�tify thet I am properly IicanseA as a contractor untlar SQ. FT. the State of Celifornia Business antl Ptofessions Code, Division 3, THE AMOUNTSHOWN UNDER VALVATION Chepter 9, and that such lieenses are in full forca antl effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE am exampt from the provislons of the Stete of Calitornia Business VALVATION PE0.MIT FEE $ antl Professions Catla, Dlvision 3, Cheptar 9. PLAN CHECK $ SlBnature of � Pe�mlttee 5 /� TAX $ Authorizetl ABent � TOTAL PAI D $ N n m 'u m � m e h m n 0 i U uwntK M1L�univ� M. UAIC y-Z7-76 JOB ADDRESS 2708 Albatross BUILDING PERMIT N0. 4�� Pcoucoei rnuro�rrne _. .. _ neei-emTinu_a�unov .,, ,.__si__ „___ ^ �AP No. ljy-476-12 LOT T �� INSPECTIONS 5 �SOIL c�s W ATER ROUGN PLUMBING PROP. $WR. LINE � HOUSE CON. � SPRINKLING SVSTEM MISCELLANEOUS ROUGH HEnTING FNO RIR CONOITIONING TEMPORFRy SEPVICE OR POLE UNOERGROUNO � POWER � ROUGH WIR�NG TRENCHES FORMS STEEL REINF, FLOOR SYSTEM BONO BEAM STEEL REINFORCE SHEATHING I, FR�ME ANq FLASMING LATNING -- IN OUT PLASTER, BROWN COAT STRUCTURAL, FINAL NEATING, VENT., REFRIG. ANO A.C., FINAL P�UMBING, FINAL �NO GAS TEST ELECTRIC, FINAL BUILOING, FINRL SUBCONT�RA �ot.s�;, � � i �4 �� i Y'�-� � COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 877 COBTA M66A� CALIFORNIA For Applican� ►o Fill In Completely TYPE OR PRINT COSTA MESA,� CALIFORNIA 17th St.. Santa Ana Jrr �%'�No.oR USEOF � J�i/i7' XT I U EXISTING BLDfi. CENTER OF BT0.8 �' JO' REAR SIDEYARDI IEFT ' �� ( R16HT DESCRIPTION OF WORK 7 / 40' "' S Z'EDiNa 2 556 ROOMS � STORIES 2 EXTERIORWA"�.Cy iding & ROOP C�t pke 8� COVERING },}UCCO COVERIN6 ]�ingle U58 OF BUILDIIVG At/D WORK TO BE PfiRFORMED 1 HEPEBY ACI(NOWL8068 THAT 1 XAVH READ TH�B APPLICATION ANO 6TAT8 TXAT TN8 ABOVE 18 COqRER ANO AOReE TO COM� PLY WITX �LL <ITY ORO�NANC88 11ND 9TATi LAW HiOUTATiNO BUILOINO GONBTRl1GTION. SIGNATURE OP e PERMITTE '�� AUTNORIZfiD AG6 FEE RECEIVED MAR 31 iB84 FINANCE DEPT. CITY OF COSTA MESA APPLICATION POR PERMR BUILDING For Oifica Use Only euu ADDI FIRH ZONING ZONH NO.OF UB80FNE�$lnp�• R�l PLANB 2 BYILDINQ_ �}y00. W CW b OEIICRI'TION �y `�J) �-laCy JG"7 A. P. NO. ROIIe NOTE: NO EAVE OVfiRHANO SHALL BE LE65 THAN YARD3APPROVED MAIN BUILOING :OM C/L STREET) VAR. # YAROSAPPROVED ACCESSORYBUILOIN6 DATE 4 ,� � %��. �. � '�,�O�f � � � THE AMOUNT BHOWN 11NOER VALUATION 18 FOR TH8 F PURPOSE OP G8TABLIBHIN� A P6RMIT FEE ONLY. Q VAWATION � �_ m PERMIT FEE S � � 2 ` m $ ��V PLANCHECK $ �-/ �u O e � — 4 WORKERS' COMPENSATION DHCLARATON: . I hereby aHirtn under penalty oi pellury one oi the following tleclarations: ❑ I have and will maintain a cedificate ot consent to selt-Insure tor workers' compensation, as provitled for by section 3700 of the Labor Cotle, for the pertormance of the �work for whiCh �his permit is is5uetl. I have antl will maintain workers' compensation insurence, as required by section 3700 of the Labor Code, for ihe peRormance of the work for which this pertnit is issued. My�e1rp1rkers' compQnsation Insurance carrier ana policy number ara: I' 1/J�] Carrier, tl�QiV��!1 ��Yi�� PolicyNumber: Wl�.�IL'�-%LJG/� (This sec� need not be�p etetl i M p rmrt is velued at one huntlred dollars ($100) or less.) ❑ I certily that in the performanGe of the work for which this permit is issued, I shall not employ any person in any manner so es to become sublect to ihe workers' wmpensation laws f CaliforPie, and agree that it I s�ould become subject to the workars' compensation provisions of Section 3700 of ihe Labor Cotle, I sha0 fatlhwith compywiththese r v ion . p ��,/"�� `\ Applicant SignaNre: �/� rfl � Data: �� C/ �� lJ-% WARNING: FAIWRE TO SECUPE WORKERS' COMPENSATION VEfiAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND qVIL FWES UP TOONE HUNDRED THOUSAND OOLLARE ($100,000), IN ADDITION TO THE COST OF CAMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIQV 3]O60F TME LABOR CODE, INTEREST, AND ATTOFNEVS FEES. LICENSED CONTRACTORS DECLARATION: I hereby aNirm thai I am force and eflect. Lic. q_ Contrecrofs SignaWre: of Chapter 9(commencing with Section 7000) of Division 3 oi the Business a�rofessions Cotle, and my license is in fuil Class # ^ .��— Da�e: / ^ �� lL� CONSTRUC710N LENDING AGENCY: ❑ I hereby aRirtn Ihat Ihere is a consimction lending agency for the performance ot ihe work For which this permit is issued. (SeC. 3097, Civil Code). '� LentleYs Name: Lentler's Address: �� . Signawre: Date: OWNER-BUILDEH DECLARATIONS: I hereby aHirtn that under penalry o� Perjury Ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Protessions Code: Any ciry or county which requires a permit to constmct, elter, improve, demolish, or repair any stmcture, pnor to its issuance, also requires the apPlicant for such pertnit to file a signed statemam that he of she is licensed pursuent to the provisions of ihe Contradors License Law (Chapter 9(commencing with Saction 7000) of Division 3 of ihe Business and Professions Code) o� thal he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit sublecis tha applicant to a civil penalry of not more than five hundred dollars ($500).): ❑ I, as owner of ihe properry, or my employees wit� wages as iheir sola compensa�ion, WILL DO 7HE WORK, anC Ihe stmcWre is not intendetl or oHered for sale (Sec. 7044, Business and Protessitlns Code: The Coniractors License Law does not apply to an owner of propetly who builds or improves thereon, and who does such work himself or hereeN or ihrough nis or her own employees, pmvided that such improvemenis are not intentled or ofleretl for sale. If, however, the building or impmvement is soltl within one year oi completion, ihe owner-builder wili have �he burden ot proving that he or she ditl not build or improve for purpose of sale.�. ❑ I, as owner oi ihe property, am E%CIUSIVELV CONTRALTING WITH LICENSED CONTRACTORS to constmct the prolect (Sec. 7044, Business antl Professions Code: The contractors LicenSe Lew does not apply lo en owner ol propetly who builtls or improves ihereon, and who contrecis for such project with a coniractor(s) license pursuant to the Contr2ctors License Laws.�. ❑ I am exempt under sec. _ Business and Pmfessions Cotle for this reason: SignaWre: Date: Owner ID verified by dmer's IicensR� ❑ �es ❑ No Driver's License No. Verification of Owners�ip by (type d document, i.a. - pmperty taa bill or tleetlJ: DIVISION OF INDUS7RIAL SAFEYY PERMIT CERTIFICATION: Expires: ❑ I hereby certify ihat no excavation tive (5) or more feet in depth into which a person is requiretl to descend, wiil be made in connection with work authorizetl by ihis permit, and Ihat no building sWcture, scaflolding, falsework, or demolition or dismantling thereoi, will be more than ihirty-six (36) feet high. (C�ap. 32, Grp 2, Art 2, Sec. 341, Title B, Califomia Atlminisirelive Cotle). ❑ As owner-builder, I will not employ anyone to tlo work which would require a permit fmm Ihe Division of Industriel Selery, as noted above, unless such person has a permit to do SUCh work from tne division. Signawre: Date: Division of Intlustnal Safery Permit Number: CERTIFICATE OF COMPLJANCE AND AUTHORIZATON OF ENTRV: I cenity under penalty of perjury that I have read ihis application and state that ihe information given is correct I agree b comply with all state laws and ciry ordinances ralating to building consimction, and authorize representatives ot ihe City of Costa Mesa m enter upon Ihe ebove-described properry for inspedion purposes. 1 agree not to occupy or allow acupancy of any buiiding authorized by ihis permit uMil finel inspection. � '/� � ignaWrg% 1� I Owner(s) � ��j Da� � — A �S AnN r Authorized Applicant Date �OpE �, INSPECTIONTYPE 1616 Fixed System Final Fire Preveniion 1266 PoolSpa Final 200 Final Re-Roof 201 FInaI BIocWRetaining Wall 202 203 Final Factory Fire Place Final Sign 204 Final Demolition QAlf, I ITIp COUEN INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Elecirical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Sile 250 Final Builtling/Occupancy QAj[ INTRIRLS